Does intermittent sun exposure cause basal cell carcinoma? a case-control study in Western Australia

Clinical features, surgical management and outcome of squamous and basal cell carcinoma in squamates and chelonians

BACKGROUND

Squamous cell carcinoma (SCC) is one of the most commonly diagnosed neoplastic disorders in reptiles. Recently, however, it has been demonstrated that basal cell carcinomas (BCCs) are frequently misclassified as SCCs. Several histological SCC and BCC variants have been characterised and their classification may allow the establishment of appropriate prognosis estimation and treatment approaches.

HYPOTHESIS/OBJECTIVES

To describe the clinical features and surgical outcomes of SCCs and BCCs diagnosed between 2010 and 2022 in reptiles.

ANIMALS

Thirty-three captive reptiles (21 squamates and 12 chelonians).

MATERIALS AND METHODS

Detailed clinical history, including staging and surgical outcomes, were performed. Statistical analysis assessed significant factors using Prism (v8.2.1).

RESULTS

While SCC was predominantly diagnosed in lizards, BCC was most commonly diagnosed in chelonians, and both neoplasms mainly occurred in adult to aged, male individuals. Although the gross pathological findings were highly comparable between SCC and BCC, considerable variation could be seen according to the primary location (oral, cutaneous or epidermis of the shell). Humane euthanasia or noncurative intent surgeries were performed in a minority of the cases. Curative intent surgeries were successful in 19 of 27 cases during a 1- to 7-year follow-up period, yet recurrence was seen in 8 cases. The results of this study allowed the identification of significant high-risk prognostic factors for SCC and BCC in reptiles.

CONCLUSIONS AND CLINICAL RELEVANCE

This study contributes to predicting the clinical behaviour and prognosis of distinct SCC and BCC histological variants, and selecting the most appropriate treatment protocol.

S2k guideline basal cell carcinoma of the skin (update 2023)

Basal cell carcinoma is the most common malignant tumor in the fair-skinned population and its incidence continues to rise. An update of the S2k guideline with the participation of all specialist societies familiar with the clinical picture and previous literature research is of great importance for the quality of care for affected patients. In addition to epidemiology, diagnostics and histology are discussed. After risk stratification, therapy is divided into topical, systemic and radiation therapy. Surgical removal remains the treatment of first choice in most cases. The approval of anti-PD1 inhibitors for locally advanced and metastatic tumors has opened up a new option in second-line therapy (after hedgehog inhibitors).

Understanding and managing locally advanced basal cell carcinoma: insights into pathogenesis, therapeutic strategies, and the role of hedgehog pathway inhibitors

Understanding and managing locally advanced basal cell carcinoma (BCC) is crucial given its substantial prevalence and potential for local tissue destruction. While BCC typically exhibits low metastatic potential, its high incidence underscores the need for enhanced therapeutic strategies. Locally advanced BCC presents unique challenges, often necessitating aggressive interventions to prevent disfigurement and functional impairment. The emergence of hedgehog pathway inhibitors (HHIs) offers promising therapeutic avenues by targeting aberrant hedgehog signaling, a key driver in BCC pathogenesis. Thus, elucidating the pathogenesis of locally advanced BCC and exploring the role of HHIs are critical endeavors in effectively managing this prevalent carcinoma. Epidemiologically, BCC primarily affects individuals with fair skin and chronic sun exposure, with an increasing incidence noted among younger age groups. Risk factors include UV radiation exposure, familial history of skin cancer, immunosuppression, and genetic syndromes such as basal cell nevus syndrome and xeroderma pigmentosum. Pathogenetically, BCC arises from cells in the skin's epidermis, with hedgehog pathway activation being a primary genetic driver, involving mutations in PTCH1 and SMO. Resistance to hedgehog inhibitors may occur due to genetic changes, complicating treatment strategies. BCC is characterized by low immunogenicity, which hinders immune response and contributes to treatment challenges. Enhanced understanding of the epidemiology, risk factors, and pathogenesis of locally advanced BCC, along with the development of targeted therapeutic approaches such as hedgehog pathway inhibitors, is essential for effectively managing this prevalent carcinoma and improving patient outcomes.

Incidence and trends of first basal cell carcinomas in France between 1980 and 2019: a regional population-based registry study

BACKGROUND

Basal cell carcinoma (BCC) is the most frequent malignancy reported in populations with fair skin. In most countries, BCCs are only partially or not at all recorded, and incidence data are lacking.

OBJECTIVES

This study assessed the current incidence rates and trends in the only two French départements where BCCs have been recorded for several decades.

METHODS

This regional population-based study thus used data from two French cancer registries (Doubs and Haut-Rhin) where first-time BCC diagnoses were recorded. The European age-standardized incidence rates (EASR) were calculated per 100 000 person-years (PY). The trends and the annual percentages of change were assessed using joinpoint analysis.

RESULTS

In all, 48 989 patients were diagnosed with a first BCC in the study period. The median age at diagnosis was 69 years and the BCCs were mainly located on the head and neck (68.8%). In the Doubs area between 1980 and 2016, the EASR of BCC increased from 59.9 to 183.1 per 100 000 PY. The annual increase for men was 5.73% before 1999 and 1.49% thereafter, and among women 4.56% before 2001 and 1.31% thereafter. In the Haut-Rhin area, the EASR increased from 139.2 in 1991 to 182.8 per 100 000 PY in 2019. Among men, the EASR increased annually by 2.31% before 2000, and by 0.29% after 2000; among women, it increased by 0.95% over the entire period (1991-2019). In the most recent period and for these two départements, the age-specific incidence rates of BCC for men and women were close before the age of 60 years, except for the 40-49-year age group, where the rates were significantly higher among women. For patients aged 60 years and over, men had much higher rates of BCC.

CONCLUSIONS

BCC incidence has increased since 1980 and is still rising, particularly among men and the elderly. A slowing was observed from 2000, which could be explained by a shift in the management of BCCs and by the possible efficacy of prevention actions. This study provides insight into the BCC burden in France and highlights the need to maintain effective prevention strategies, as incidence is still increasing.

Legislative review and recommendations for improving sun protection in schools

BACKGROUND

Sun exposure in schools can account for a large portion of childhood sun exposure before the age of 20 years, yet legislation in the United States is lacking to properly protect children. Schools serve as a foundational resource to introduce and implement sun-safe practices in the youth population.

METHODS

Federal and state legislation relating to the access of sunscreen, sun-protective apparel, and shade was reviewed via the website LegiScan.com.

RESULTS

At the time of publication, only 25 states have legislation in place that addresses and allows sunscreen to be used in school, given its classification as an over-the-counter medication. No state has implemented legislation allowing sunglasses to be worn in school, and only two states have laws explicitly allowing hats and other sun-protective apparel at schools. In addition, the provision of shade is addressed in four states.

CONCLUSIONS

With a significant portion of sun exposure occurring at schools, state and federal legislation must address sun protection for students, opening the door for expanded access and additional research related to skin cancer prevention.

A UV-related risk analysis in ophthalmic malignancies: Increased UV exposure may cause ocular malignancies

Purpose

To explore the role of ultraviolet radiation (UVR) in the occurrence and development of various ocular malignancies.

Methods

In this article, we retrieved ocular malignancy data from the Global Cancer Observatory (GCO) and performed correlation analysis with the global UV index and sunshine duration. We searched for associated studies using the following databases: Embase, Pubmed, Cochrane Library, and Google Scholar. We conducted the literature by searching the Mesh terms denoting an exposure of interest ("UV radiation", "ultraviolet rays", and "ocular malignancies", All studies included are published until December 30, 2023 without language restrictions.

Results

The mechanisms and epidemiological statistics of UVR on the onset and progression of eyelid malignancies are the most studied and clear. The role of UVR in conjunctival melanoma is similar to that in eyelid melanoma. The relationship between uveal melanoma and UVR is controversial, however, it may have at least a certain impact on its prognosis. UVR causes ocular surface squamous neoplasia by further activating HPV infection.

Conclusions

UVR is a decisive risk factor for ocular malignancies, but the incidence of ultraviolet-induced tumors is also affected by many other factors. A correct and comprehensive understanding of the mechanisms of UVR in the pathogenesis of ocular malignant tumors can provide patients with more effective and selective immune regulation strategies.

Interdisciplinary management of skin cancer

The interdisciplinary treatment of skin cancer in the head and neck area requires close collaboration between different specialist disciplines. The most common non-melanoma skin cancer tumor entities are cutaneous squamous cell carcinoma and basal cell carcinoma as well as their precursor lesions. One of the less common tumors is Merkel cell carcinoma, which also occurs primarily in light-exposed areas and, in contrast to squamous and basal cell carcinoma, is more likely to metastasize. Due to the low tendency of basal cell carcinoma as well as cutaneous squamous cell carcinoma to metastasize, a cure can often be achieved by surgery. If the tumor growth exceeds certain levels it may require collaboration between dermatology and otorhinolaryngology. The primary goal of this interdisciplinary collaboration is to achieve a functional, cosmetically and aesthetically acceptable result in addition to adequate tumor treatment. Depending on the stage of the tumor and the clinical course, a case may be discussed in an interdisciplinary tumor board in order to determine a personalised, appropriate and adequate treatment concept for each patient, including prevention, therapy and follow-up.

New graphene-containing pharmaceutical formulations for infrared lamps-based phototherapy of skin cancer: In vitro validation and ex-vivo human skin permeation

Basal cell carcinoma (BCC) is the most common form of human cancer, and treatment usually involves surgery, with alternative strategies being needed. We propose the use of carbopol hydrogels (HG) for topical administration of nanographene oxide (GOn) and partially-reduced nanographene oxide (p-rGOn) for photothermal therapy (PTT) of BCC. GOn and p-rGOn incorporated into the HG present lateral sizes ∼200 nm, being stable for 8 months. After 20 min irradiation with an infrared (IR) photothermal therapy lamp (15.70 mW cm-2), GOn-HG increased temperature to 44.7 °C, while p-rGOn-HG reached 47.0 °C. Human skin fibroblasts (HFF-1) cultured with both hydrogels (250 μg mL-1) maintained their morphology and viability. After 20 min IR irradiation, p-rGOn HG (250 μg mL-1) completely eradicated skin cancer cells (A-431). Ex vivo human skin permeability tests showed that the materials can successfully achieve therapeutic concentrations (250 μg mL-1) inside the skin, in 2.0 h for GO HG or 0.5 h for p-rGOn HG.

A Population-Based Family Case-Control Study of Sun Exposure and Follicular Lymphoma Risk

BACKGROUND

Epidemiologic evidence suggests an inverse association between sun exposure and follicular lymphoma risk.

METHODS

We conducted an Australian population-based family case-control study based on 666 cases and 459 controls (288 related, 171 unrelated). Participants completed a lifetime residence and work calendar and recalled outdoor hours on weekdays, weekends, and holidays in the warmer and cooler months at ages 10, 20, 30, and 40 years, and clothing types worn in the warmer months. We used a group-based trajectory modeling approach to identify outdoor hour trajectories over time and examined associations with follicular lymphoma risk using logistic regression.

RESULTS

We observed an inverse association between follicular lymphoma risk and several measures of high lifetime sun exposure, particularly intermittent exposure (weekends, holidays). Associations included reduced risk with increasing time outdoors on holidays in the warmer months [highest category OR = 0.56; 95% confidence interval (CI), 0.42-0.76; Ptrend < 0.01], high outdoor hours on weekends in the warmer months (highest category OR = 0.71; 95% CI, 0.52-0.96), and increasing time outdoors in the warmer and cooler months combined (highest category OR = 0.66; 95% CI, 0.50-0.91; Ptrend 0.01). Risk was reduced for high outdoor hour maintainers in the warmer months across the decade years (OR = 0.71; 95% CI, 0.53-0.96).

CONCLUSIONS

High total and intermittent sun exposure, particularly in the warmer months, may be protective against the development of follicular lymphoma.

IMPACT

Although sun exposure is not recommended as a cancer control policy, confirming this association may provide insights regarding the future control of this intractable malignancy.

The Burden of Skin Cancers in Saudi Arabia Through 2011-2022

Introduction Skin cancers are classified into melanoma and non-melanoma or keratinocyte cancers. No recent data are found about the epidemiology of skin cancers in Saudi Arabia. The current study aims to determine the burden of skin cancer in the last 11 years from 2011 to 2022. Methods Patients who were diagnosed with any type of skin cancer were enrolled in the study. The diagnosis was conducted based on histopathology and immunohistochemistry. Different variables like age, type of cancer, type of lesions, and treatment approach used were measured. Results A total of 91 patients were diagnosed with skin cancers during the study period. The head and neck were the most common sites for skin cancers. Only 4/91 cases reported invasive melanoma. Both squamous cell carcinoma (SCC) (34/91) and basal cell carcinoma (BCC) (28/91) were found to be the most reported skin cancers. Other cancers including mycosis fungoides (MF) (10/91), Kaposi's sarcoma (6/91), and dermatofibrosarcoma protuberans (DFSP) (5/91) were also detected. The rest of the detected tumors were rarely detected. Aggressive CD4+/CD4+/CD8+ MF was more prevalent than CD3+/CD4+/CD8- MF cancer cases. CD34+ /S100- DFSP cancers were evident in most of the DFSP cases. Human herpes virus 8 was detected in all Kaposi's sarcoma cases and all of them were HIV-confirmed cases. Surgical treatment was the most frequently used approach to treat skin cancers, followed by phototherapy (9.9%), surgical/radiotherapy (5.5%), surgical/chemotherapy (4.4%), chemotherapy (3.3%), and then chemoradiotherapy immunotherapy (1.1%). Conclusion The incidences of SCC and BCC are relatively high in comparison to other types of skin cancers with the surgical intervention being most frequently used.

[Current Management of Basal Cell Carcinoma]

For the management of basal cell carcinoma, the primary performance of a risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important.Various non-invasive methods are available to confirm the clinical diagnosis. Histological confirmation of the diagnosis is recommended in unclear cases. In poorly displaced lesions, preoperative cross-sectional imaging of the tumor area should be performed to exclude osseous infiltration.The gold standard in treatment remains surgery, which should be performed by means of micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy or application of 5-fluorouracil or imiquimod), which can be used in certain cases. Also for advanced or metastatic basal cell carcinoma, effective drugs are available in the form of the hedgehog inhibitors, for which there is now several years of application experience with regard to efficacy and handling of adverse events. With the PD-1 inhibitor cemiplimab, a further therapeutic option for non-operable or metastatic tumors has been available since June 2021.The most important preventive measure is consistent textile or chemical UV protection in already affected individuals. In addition, nicotinamide and celecoxib can be used orally for prevention. For follow-up, the current S2k guideline recommends regular self-monitoring and standardized medical check-ups.

A meta-analysis of sunburn and basal cell carcinoma risk

Basal cell carcinoma (BCC) is the most common cancer in the United States. Sunburn is a modifiable risk factor for BCC. The objective of this project was to synthesize research on BCC and sunburn to quantify the impact and severity of sunburn at different life stages on BCC risk in the general population. A systematic literature search of four electronic databases was conducted and data were extracted by two independent reviewers using standardized forms. Data from 38 studies were pooled using both dichotomous and dose-response meta-analytic methods. BCC risk increased with ever experiencing a sunburn in childhood (OR=1.43, 95% CI: 1.19, 1.72) and with ever experiencing a sunburn in life (OR= 1.40, 95% CI: 1.02, 1.45). Every five sunburns experienced per decade in childhood increased BCC risk by 1.86 (95% CI: 1.73, 2.00) times. Every five sunburns experienced per decade in adulthood increased BCC risk by 2.12 (95% CI: 1.75, 2.57) times and every five sunburns per decade of life increased BCC risk by 1.91 (95% CI: 1.42, 2.58) times. The data on sunburn exposure and BCC show that an increase in number of sunburns at any age increased the risk of BCC. This may inform future prevention efforts.

Lower lip basal cell and squamous cell carcinomas: a reappraisal of the similarities and differences in clinical presentation and management

Basal cell carcinoma and squamous cell carcinoma are the two most common types of carcinomas, affecting a total of 5.4 million people each year in the United States. Sun-exposed areas, especially the face and nose, are most affected given the strong association between these carcinomas and ultraviolet radiation. Less research has been done surrounding carcinomas of the lip, despite the significant aesthetic and functional importance of this area. Although lip carcinomas tend to follow a classic, unique distribution pattern that favors basal cell carcinoma on the upper lip and squamous cell carcinoma on the lower lip, more cases of lower lip basal cell carcinoma are being reported, warranting further educational awareness to differentiate carcinomas of the lower lip. In this article, we provide an updated overview of the risk factors, presentations, differential diagnoses, metastatic risks, evaluation, management guidelines, and outcomes of lower lip carcinoma. Of note, recent advances in imaging modalities are beginning to show promise as a non-invasive, affordable, and rapid way to detect and stage tumors. We conclude that increased clinical awareness and investigation of lower lip carcinoma is needed to improve early intervention, as a delayed diagnosis can rapidly alter the management and outcomes of lip carcinomas.

The epidemiology, healthcare and societal burden of basal cell carcinoma in Wales 2000-2018: a retrospective nationwide analysis

BACKGROUND

Basal cell carcinoma (BCC) represents the most commonly occurring cancer worldwide within the white population. Reports predict 298 308 cases of BCC in the UK by 2025, at a cost of £265-366 million to the National Health Service (NHS). Despite the morbidity, societal and healthcare pressures brought about by BCC, routinely collected healthcare data and global registration remain limited.

OBJECTIVES

To calculate the incidence of BCC in Wales between 2000 and 2018 and to establish the related healthcare utilization and estimated cost of care.

METHODS

The Secure Anonymised Information Linkage (SAIL) databank is one of the largest and most robust health and social care data repositories in the UK. Cancer registry data were linked to routinely collected healthcare databases between 2000 and 2018. Pathological data from Swansea Bay University Health Board (SBUHB) were used for internal validation.

RESULTS

A total of 61 404 histologically proven BCCs were identified within the SAIL Databank during the study period. The European age-standardized incidence for BCC in 2018 was 224.6 per 100 000 person-years. Based on validated regional data, a 45% greater incidence was noted within SBUHB pathology vs. matched regions within SAIL between 2016 and 2018. A negative association between deprivation and incidence was noted with a higher incidence in the least socially deprived and rural dwellers. Approximately 2% travelled 25-50 miles for dermatological services compared with 37% for plastic surgery. Estimated NHS costs of surgically managed lesions for 2002-2019 equated to £119.2-164.4 million.

CONCLUSIONS

Robust epidemiological data that are internationally comparable and representative are scarce for nonmelanoma skin cancer. The rising global incidence coupled with struggling healthcare systems in the post-COVID-19 recovery period serve to intensify the societal and healthcare impact. This study is the first to demonstrate the incidence of BCC in Wales and is one of a small number in the UK using internally validated large cohort datasets. Furthermore, our findings demonstrate one of the highest published incidences within the UK and Europe.

The GENESIS-UV study on ultraviolet radiation exposure levels in 250 occupations to foster epidemiological and legislative efforts to combat nonmelanoma skin cancer

BACKGROUND

Several hundred million of the 3 billion formally employed people worldwide are at risk from high levels of solar ultraviolet radiation (UVR). Chronic light damage to the skin can lead to nonmelanoma skin cancer (NMSC), especially when irradiation is too high and is acquired for decades. However, data with uniform metrics, high resolution over time and in-depth occupational profiles are not available.

OBJECTIVES

To build a worldwide usable matrix of UVR exposure in occupations and to show use cases for the data.

METHODS

One thousand test persons were recruited to wear electronic data logger dosimeters during their working time for 7 months each. The measurements yielded 3.7 billion data points for around 48 000 days with high-quality data capture covering more than 250 occupations and 650 activities. Scientific evaluation of the data included daily and half-hourly means, geographical transfer calculations to the world, threshold exceedance quotas, transcriptome effects, and occupational disease estimates.

RESULTS

A compendium for global use is presented. In-depth analyses and the resulting implications for research have been elaborated to directly link exposure data to effects in the human body. Interestingly, the annual irradiances of the different occupations span a wide range of values: from about 650 to 50 standard erythemal doses, with different distributions over the months. Detailed exposure data per occupation were derived, and the risk on an occupational or activity basis assuming different exposure level quotas was quantified. This showed that, for example, in temperate latitudes, all activities with a duration of > 2 h outdoors are associated with increased NMSC risk.

CONCLUSIONS

We offer our work to enable sound studies on the nature of ultraviolet-induced skin cancer, dose-response relationships, intermittency of skin exposure, and derivation of limit values. Sociological studies on prevention are now possible. Practitioners may use the findings for their daily work with employees.

Trends in keratinocyte skin cancer incidence, mortality and burden of disease in 33 countries between 1990 and 2017

BACKGROUND

Keratinocyte cancers (KCs) are the most common type of cancer in the White population worldwide, with associated high healthcare costs. Understanding the epidemiological trends for KCs, namely basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (SCCs), is required to assess burden of disease, project future trends and identify strategies for addressing this pressing global health issue.

OBJECTIVES

To report trends in BCC and SCC incidence, and SCC mortality and disability-adjusted life-years (DALYs).

METHODS

An observational study of the Global Burden of Disease (GBD) database between 1990 and 2017 was performed. European Union countries and other selected high-income countries, including the UK and the USA, classified as having high-quality mortality data, were included. Annual age-standardized incidence rates (ASIRs), age-standardized death rates (ASDRs) and DALYs for each country were obtained from the GBD database. Trends were described using joinpoint regression analysis.

RESULTS

Overall, 33 countries were included. For both BCC and SCC in 2015-2017, the highest ASIRs were observed in the USA and Australia. Males had higher ASIRs than females at the end of the observation period in all countries for SCC, and in all countries but two for BCC. In contrast, the highest ASDRs for SCC were observed in Australia and Latvia for males, and in Romania and Croatia for females. The highest DALYs for SCC for both sexes were seen in Australia and Romania. Over the observation period, there were more countries demonstrating decreasing trends in mortality than in incidence, and disparities were observed between which countries had comparatively high mortality rates and which had high incidence rates. Overall reductions in SCC DALYs were observed in 24 of 33 countries for males, and 25 countries for females.

CONCLUSIONS

Over the past 27 years, although trends in SCC incidence have risen in most countries, there is evidence that mortality rates have been decreasing. Burden of disease as assessed using DALYs has decreased in the majority of countries. Future work will explore potential explanatory factors for the observed disparity in trends in SCC incidence and mortality.

[Current Management of Basal Cell Carcinoma]

AIM OF STUDY

We present the current standard in diagnosis and treatment of basal cell carcinoma. Useful procedures for clinical management should be derived from this.

METHODS

A systematic literature search was carried out in the PubMed online database. The collected information was analyzed and evaluated. An overall concept was created from the gained knowledge.

RESULTS

Basal cell carcinoma is the most common tumor in humans and its incidence is expected to increase in the future. When managing the disease, a one-dimensional orientation towards the clinical or histological subtype is not sufficient because of the heterogeneity of the tumor. The primary implementation of risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important. The gold standard in treatment continues to be the surgical procedure, which should be carried out using micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy, application of 5-fluorouracil or imiquimod), which can be used in certain cases. Hedgehog inhibitors are also effective drugs for advanced or metastatic basal cell carcinoma. Practitioners have gained several years of experience with regard to effectiveness and handling of adverse events. With the PD-1 inhibitor cemiplimab, another therapeutic option for inoperable or metastatic tumors has been available since June 2021.

CONCLUSION

Basal cell carcinoma will continue to gain in relevance in daily dermatological practice in the coming years. A structured approach to the assessment of the existing risk category of the tumor and the subsequent determination of the optimal therapy regimen are of central importance. Advanced or metastatic tumors no longer represent a hopeless situation for the patient. With long-termhedgehog therapy, an adapted dosage scheme can avoid discontinuation of therapy due to side effects. The therapeutic potential of the PD-1 inhibitor cemiplimab can also be used with the side effect profile known from other types of skin cancer.

Risk of Non-cutaneous Cancers in Individuals with Basal Cell Carcinoma: A Population-based Cohort Study

Evidence of the association between a personal history of basal cell carcinoma and the risk of non-cutaneous malignancies is conflicting. The aim of this study was to retrospectively clarify the risk of non-cutaneous cancers in individuals with basal cell carcinoma using nationwide Finnish registry data for 96,304 patients and 394,503 randomly selected population controls. In this study, individuals with basal cell carcinoma have an increased risk of other cancers (odds ratio (OR) 1.38; 95% confidence interval (95% CI) 1.36-1.40). The risk was most prominent for lip cancer (OR 5.29; 95% CI 4.50-6.21), mycosis fungoides (OR 3.13; 95% CI 2.31-4.23) and soft tissue cancers (OR 2.77; 95% CI 2.43-3.16). In age-adjusted model, men had higher risk of cancers overall compared with women (p < 0.05). In conclusion, the study found increased overall cancer risk among patients with basal cell carcinoma compared with randomly selected population controls.

Review on photoprotection: a clinician’s guide to the ingredients, characteristics, adverse effects, and disease-specific benefits of chemical and physical sunscreen compounds

Photoprotection is a critical health prevention strategy to reduce the deleterious effects of ultraviolet radiation (UVR) and visible light (VL). Methods of photoprotection are reviewed in this paper, with an emphasis on sunscreen. The most appropriate sunscreen formulation for personal use depends on several factors. Active sunscreen ingredients vary in their protective effect over the UVR and VL spectrum. There are dermatologic diseases that cause photosensitivity or that are aggravated by a particular action spectrum. In these situations, sunscreen suggestions can address the specific concern. Sunscreen does not represent a single entity. Appropriate personalized sunscreen selection is critical to improve compliance and clinical outcomes. Health care providers can facilitate informed product selection with awareness of evolving sunscreen formulations and counseling patients on appropriate use. This review aims to summarize different forms of photoprotection, discuss absorption of sunscreen ingredients, possible adverse effects, and disease-specific preferences for chemical, physical or oral agents that may decrease UVR and VL harmful effects.

Cryotherapy as an Effective therapeutic Option in Patients with Nodular Basal Cell Carcinoma - Case Report

Basal cell carcinoma (BCC) is a malignant tumor originating from epidermal cells. A case of BCC was reported in a 67-year-old female, with the initial complaint of skin-colored papules, which later turned into a nodule with erosion and crusts on the right shoulder. The diagnosis is established from findings consistent with nodular BCC on physical examination, and from dermoscopic appearance revealing ulceration, blue-gray ovoid nests, deeply pigmented border, and arborizing vessels. Histopathological examination showed tumor cells forming palisading structures with myxoid stroma, polymorphic, hyperchromatic and mitotic nuclei, as well as fibrocollagen connective tissue cells with lymphocyte infiltrates. Cryotherapy is a therapeutic option for BCC in old patients and has a cure rate of around 95%. Observation on the 25th day revealed clinical improvement with reduced nodular lesion size; thus, further cryotherapy was needed to enhance the therapeutic outcomes.

Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas

BACKGROUND

Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring.

METHODS

Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019.

RESULTS

The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors.

CONCLUSIONS

The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs.

Basal Cell Carcinoma: A Narrative Review on Contemporary Diagnosis and Management

Basal cell carcinoma (BCC) is the most common, accounting for 80–90% of skin cancers. It arises from the basal layer of the epidermis and its appendages. A complex interplay of environmental, phenotypic and genetic variables leads to the development of BCC. Literature has documented several clinical subtypes of BCC, the most common of which are nodular, superficial and morpheaform. Expeditious diagnosis and analysis are essential for improving the outcome of BCC. Preventive measures, particularly when implemented in childhood and adolescence, may play a critical role. Due to its low metastatic potential, treatment for BCC mostly focuses on local management. The standard treatment of basal cell carcinoma involved complete removal of the lesion by excision or Mohs surgery. In special circumstances, basal cell carcinoma can be treated with cryosurgery, electrodesiccation and curettage, topical medications and photodynamic therapy. This review aimed to evaluate the contemporary diagnosis and management of basal cell carcinoma.

Probing Different Approaches in Ultraviolet Radiation Personal Dosimetry - Ball Sports and Visiting Parks

Solar ultraviolet radiation (UVR) continues to be a decisive influencing factor for skin health. Besides acute damage (e.g. erythema), chronic light damage is of particular relevance. Skin cancer can develop on the basis of this light damage. Knowledge about irradiation is crucial for the choice of preventive measures, but has so far been incomplete in many occupational and leisure activities. Often a methodological problem in study design is the cause. Here we report on the clarification of two issues. First, further values are to be determined on the way to a comprehensive exposure register of leisure-related activities. Furthermore, it is to be determined to what extent the measurement setting can have an influence on the measurement campaigns. For long-term measurements, football referees were equipped with dosimeters over several months, selective measurements during visits to parks were carried out by on-site recruitment of test persons. It turned out that the choice of method also depends on the expected compliance of the test persons. Long-term measurements of specific activities such as playing football are particularly suitable for observing the course of UV exposure over the year and generating resilient mean values. Point measurements such as visits to parks can also do this if there are enough such events spread over the year. However, they are particularly suitable for such on-site campaigns, as they may be combined with awareness campaigns of the issue of skin cancer. They also allow many measurements to be taken at the same time in one place. Both playing football and visiting parks are associated with high levels of radiation, so specific prevention concepts need to be developed. We were able to determine that the sunburn dose for light skin types was reached or exceeded for both of the investigated activities.

Basal Cell Carcinoma: an updated review of pathogenesis and treatment options

Basal cell carcinoma (BCC) remains the most common malignancy worldwide. BCC pathogenesis is a result of the interplay between one's environment, genetics, and phenotypic factors. BCC has a low mortality but given its increasing incidence and potential to cause local destruction thus resulting in significant morbidity, it is vital for dermatologists to remain up to date with recent updates in this malignancy's pathogenesis and treatment. This article provides a comprehensive review of the pathogenesis of BCC as well as the current treatments available and clinical trials underway. We also touch upon the updated National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in respect to BCC's recommended treatment modalities.

Non-melanoma skin cancer among ethnic German immigrants (resettler) from the former Soviet Union: a cohort study from 1990 to 2007

Background

UV radiation is a significant risk factor for non-melanoma skin cancer (NMSC). Ethnic Germans (resettlers) who immigrated to Germany from the former Soviet Union may have had a relatively high UV light exposure and thus a higher risk of developing NMSC. We compared the incidence of NMSC in a resettler cohort with the general population of the Saarland (Federal state of Germany) in relation to tumour location.

Methods

All new NMSC cases (resettler cohort and total population) between 1990 and 2007 were retrieved from the Saarland cancer registry and classified according to sex, histology, and location. The classification used for tumour location approximated the previous UV exposure. Age-standardized incidence rates (ASR) for the general population and standardized incidence ratios (SIR) for resettlers compared to the general population were calculated and modelled using Poisson regression.

Results

Sex-specific overall SIR indicated a significant increase in female resettlers (SIR 1.31 (95% CI 1.02–1.67)) which can mostly be attributed to an increased incidence of squamous cell carcinoma. The regression analysis showed that among resettlers the risk of developing tumours in UV-exposed skin areas was 2.16 (95% CI 1.35–3.45) higher compared to the general population.

Conclusions

Female resettlers have a higher risk to be diagnosed with NMSC than the general German population. Based on the observed distribution of tumour location, it is suspected that UV exposure contributed significantly to this risk.

Eyelid malignancies in young individuals: clinical peculiarities

OBJECTIVE

The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The purpose of this study was to identify particularities in individuals under 40 years of age affected by eyelid malignancies.

METHODS

Clinical charts of patients under 40 years of age who underwent eyelid tumor excision from 2014 to 2020 in two reference centers, one in Brazil and one in the USA, were reviewed. Demographic and outcome measures included: age, gender, skin phototype, comorbidities, diagnosis, time until diagnosis, lesion location, recurrence and metastasis. In addition, associated characteristics, including chronic sun exposure, intentional tanning (outdoor or artificial), history of smoking, use of sunscreen, family history of skin cancer and exposure to pesticides or herbicides, were reviewed.

RESULTS

A total of 24 malignant eyelid tumors from 17 patients were identified. Twelve (70.6%) patients were female, and the most prevalent tumor was basal cell carcinoma (62.5%). Three (17.6%) patients had xeroderma pigmentosum and presented with multiple lesions. Family history of skin cancer was reported by 47% of patients. Prolonged sun exposure was reported by 41.2%; history of smoking and intentional tanning were reported by 23.5 and 17.6%, respectively, and might have played a role in carcinogenesis.

CONCLUSIONS

Although uncommon in young subjects, eyelid malignancies present some peculiarities in individuals under 40 years of age. Our results suggest that women with family history of skin cancer and history of chronic exposure to ultraviolet radiation are at risk. Association with genetic syndromes is also relevant among younger age groups.

Wounding Therapies for Prevention of Photocarcinogenesis

The occurrence of non-melanoma skin cancer (NMSC) is closely linked with advanced age and ultraviolet-B (UVB) exposure. More specifically, the development of NMSC is linked to diminished insulin-like growth factor-1 (IGF-1) signaling from senescent dermal fibroblasts in geriatric skin. Consequently, keratinocyte IGF-1 receptor (IGF-1R) remains inactive, resulting in failure to induce appropriate protective responses including DNA repair and cell cycle checkpoint signaling. This allows UVB-induced DNA damage to proliferate unchecked, which increases the likelihood of malignant transformation. NMSC is estimated to occur in 3.3 million individuals annually. The rising incidence results in increased morbidity and significant healthcare costs, which necessitate identification of effective treatment modalities. In this review, we highlight the pathogenesis of NMSC and discuss the potential of novel preventative therapies. In particular, wounding therapies such as dermabrasion, microneedling, chemical peeling, and fractionated laser resurfacing have been shown to restore IGF-1/IGF-1R signaling in geriatric skin and suppress the propagation of UVB-damaged keratinocytes. This wounding response effectively rejuvenates geriatric skin and decreases the incidence of age-associated NMSC.

Modern understanding of the pathogenesis of basal cell skin cancer

The incidence of basal cell skin cancer is increasing worldwide. The initiation and progression of basal cell skin cancer is due to the interaction of environmental factors and the patient's genetic characteristics. Aberrant activation of the transmission of the Hedgehog signaling pathway is the main pathogenetic pathway of carcinogenesis. Since basal cell skin cancer is manifested by significant variability of morphological structure, aggressiveness and response to treatment, the disclosure of the molecular genetics of pathogenesis will become the basis for developing new approaches and increasing the effectiveness of treatment, as well as overcoming tumor resistance to treatment. To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.

Aktuelles Management des Basalzellkarzinoms

Ziel der Studie Der aktuelle Standard von Diagnostik und Therapie des Basalzellkarzinoms soll dargestellt werden. Hieraus sollen sinnvolle Vorgehensweisen für das klinische Management abgeleitet werden.

Methodik Es erfolgte eine systematische Literaturrecherche in der Online-Datenbank PubMed. Die gesammelten Informationen wurden analysiert und bewertet. Aus den gewonnenen Erkenntnissen wurde ein Gesamtkonzept erstellt.

Ergebnisse Das Basalzellkarzinom ist der häufigste Tumor des Menschen und die Inzidenz wird voraussichtlich künftig weiter zunehmen. Beim Management der Erkrankung wird eine eindimensionale Orientierung am klinischen bzw. histologischen Basalzellkarzinom-Subtyp der Heterogenität des Tumors nicht gerecht. Zunehmende Bedeutung gewinnt die primäre Durchführung einer Risikostratifizierung, die für die weiteren diagnostischen und therapeutischen Schritte maßgeblich ist. Goldstandard in der Behandlung bleibt weiterhin das operative Vorgehen, welches möglichst mittels mikrografisch kontrollierter Chirurgie erfolgen sollte. Daneben existieren weitere Therapieverfahren wie die Radiotherapie oder eine Reihe an topischen Therapieoptionen (photodynamische Therapie, Kryotherapie oder Applikation von 5-Fluoruracil bzw. Imiquimod), die in bestimmten Fällen zur Anwendung kommen können. Auch für fortgeschrittene oder metastasierte Basalzellkarzinome stehen mit den Hedgehog-Inhibitoren wirksame Medikamente zur Verfügung, für die inzwischen eine mehrjährige Anwendungserfahrung hinsichtlich Wirksamkeit und Umgang mit unerwünschten Ereignissen vorliegt. Mit den PD-1-Inhibitoren steht eine weitere systemische Therapieoption in Aussicht, deren Nutzen aktuell noch in klinischen Studien überprüft wird.

Schlussfolgerung Das Basalzellkarzinom wird in den kommenden Jahren weiter an Relevanz in der täglichen dermatologischen Praxis gewinnen. Eine strukturierte Herangehensweise zur Einschätzung der vorliegenden Risikokategorie des Tumors und die anschließende Festlegung des optimalen Therapieregimes sind von zentraler Bedeutung. Fortgeschrittene oder metastasierte Tumoren stellen keine aussichtslose Situation für den Patienten mehr dar. Durch adaptierte Dosierschemata kann ein nebenwirkungsbedingter Therapieabbruch unter langfristiger Hedgehog-Therapie vermieden werden. Das therapeutische Potenzial von PD-1-Inhibitoren könnte bald auch beim Basalzellkarzinom genutzt werden.

[Alterations of the anterior segment of the eye caused by exposure to UV radiation]

BACKGROUND

By identifying diseases of the anterior segment of the eye associated with exposure to UV light, recommendations for action can be derived.

AIM

After reading this review, the reader should be familiar with UV light-associated diseases of the anterior segment of the eye.

METHOD

Using a selective literature search, UV light-associated diseases of the anterior segment of the eye were identified and protective mechanisms are described.

RESULTS

The UV light-associated lesions of the anterior segment of the eye include basal cell and squamous cell carcinomas, malignant melanoma of the eyelids and conjunctiva, pterygium, keratoconjunctivitis photoelectrica and climatic droplet keratopathy as well as cortical cataract.

CONCLUSION

Eyeglasses for filtering UV light, sunglasses and special safety glasses, such as welding helmets and wearing headgear protect against UV light exposure to the anterior segment of the eye and the associated diseases.

A nationwide study of the incidence and trends of first and multiple basal cell carcinoma in the Netherlands and prediction of future incidence

BACKGROUND

Basal cell carcinoma (BCC) is the most frequently diagnosed malignancy worldwide and an ever increasing annual incidence is observed. However, nationwide registries of BCCs are very rare and often extrapolation of the data was necessary to estimate the absolute number of diagnoses. Since September 2016, all histopathologically confirmed BCCs are registered in the Netherlands, due to developments in automatic notification and import in the Netherlands cancer registry. This offers the unique possibility to assess the nationwide population-based incidence of first and multiple BCC.

OBJECTIVES

The current study aims to assess nationwide incidence and trends of first and multiple BCC in the Netherlands and to predict incidence rates up to 2029.

METHODS

All patients with histopathologically confirmed BCC between 2001 and 2019 were selected from the population-based Netherlands Cancer Registry. Age-standardized incidence rates were calculated and trends were analyzed with use of the estimated annual percentage change. Prediction of BCC incidence rates up to 2029 was based on a regression model.

RESULTS

In total, 601,806 patients were diagnosed with a first BCC over the period 2001-2019. The age-standardized incidence rates for both men and women with a first BCC increased over these years from 158 to 304 and 124 to 274 per 100,000 person-years, respectively. For male and female patients aged between 30-39 years, decreases in annual incidences of -3.6% and -3.0% were found in recent years, respectively. For patients aged 50 years or older an ever increasing trend was found. A quarter of the patients with a first primary BCC developed one or more subsequent BCCs within three years. Increases in incidence of 30.4% (male) and 25.3% (female) is expected in the next 10 years.

CONCLUSIONS

BCC incidence doubled over the past decades. Trends seemed to stabilize in recent years for patients aged below 50 years. This might be a first sign of a decreasing trend. The incidence keeps rising in patients aged 50 years and older. In the next decade a further increase in BCC incidence is expected.

Ultraviolet Radiation and Basal Cell Carcinoma: An Environmental Perspective

Ultraviolet radiation (UVR) is a known carcinogen participated for the development of skin cancers. Solar UVR exposure, particularly ultraviolet B (UVB), is the mostly significant environmental risk factor for the occurrence and progress of basal cell carcinoma(BCC). Both cumulative and intermittent high-grade UVR exposure could promote the uncontrolled replication of skin cells. There are also exsiting other contributing environmental factors that combine with the UVR exposure to promote the development of BCC. DNA damage in formation of skin cancers is considered to be a result of UVR toxicity. It is UVR that could activate a series of oncogenes simultaneously inactivating tumor suppressor genes and aberrant proliferation and survival of keratinocytes that repair these damages. Furthermore, mounting evidence demonstrates that inflammatory responses of immune cells in the tumor microenvironment plays crucial role in the skin tumorigenesis as well. In this chapter, we will follow the function of UVR in the onset and development of BCC. We describe the factors that influence BCC induced by UVR, and also review the recent advances of pathogenesis of BCC induced by UVR from the genetic and inflammatory aspects.

Ultraviolet Radiation and Chronic Inflammation-Molecules and Mechanisms Involved in Skin Carcinogenesis: A Narrative Review

The process of skin carcinogenesis is still not fully understood. Both experimental and epidemiological evidence indicate that chronic inflammation is one of the hallmarks of microenvironmental-agent-mediated skin cancers and contributes to its development. Maintaining an inflammatory microenvironment is a condition leading to tumor formation. Multiple studies focus on the molecular pathways activating tumorigenesis by inflammation and indicate several biomarkers and factors that can improve diagnostic and prognostic processes in oncology and dermatology. Reactive oxygen species produced by ultraviolet radiation, oxidizers, or metabolic processes can damage cells and initiate pro-inflammatory cascades. Considering the potential role of inflammation in cancer development and metastasis, the identification of early mechanisms involved in carcinogenesis is crucial for clinical practice and scientific research. Moreover, it could lead to the progress of advanced skin cancer therapies. We focus on a comprehensive analysis of available evidence and on understanding how chronic inflammation and ultraviolet radiation can result in skin carcinogenesis. We present the inflammatory environment as complex molecular networks triggering tumorigenesis and constituting therapeutic targets.

Deiodinases and Cancer

Hormones are key drivers of cancer development, and alteration of the intratumoral concentration of thyroid hormone (TH) is a common feature of many human neoplasias. Besides the systemic control of TH levels, the expression and activity of deiodinases constitute a major mechanism for the cell-autonomous, prereceptoral control of TH action. The action of deiodinases ensures tight control of TH availability at intracellular level in a time- and tissue-specific manner, and alterations in deiodinase expression are frequent in tumors. Research over the past decades has shown that in cancer cells, a complex and dynamic expression of deiodinases is orchestrated by a network of growth factors, oncogenic proteins, and miRNA. It has become increasingly evident that this fine regulation exposes cancer cells to a dynamic concentration of TH that is functional to stimulate or inhibit various cellular functions. This review summarizes recent advances in the identification of the complex interplay between deiodinases and cancer and how this family of enzymes is relevant in cancer progression. We also discuss whether deiodinase expression could represent a diagnostic tool with which to define tumor staging in cancer treatment or even a therapeutic tool against cancer.

Clinical and epidemiological analysis of basosquamous carcinoma: results of the multicenter study

Basosquamous carcinoma (BSC) is a rare non-melanoma skin cancer that shares the characteristic features of both basal and squamous cell carcinomas (BCC, SCC). Our research enables better characterization of BSC in comparison to high-risk subtypes of BCC and SCC. Paper includes a retrospective analysis of BSC cases regarding sex, age, number of tumors and anatomical distribution in comparison to BCC and SCC evaluating the differences and defining the implications. Histologically confirmed carcinomas recorded between 1999 and 2019 were studied. 181 diagnosed BSC cases were identified, making this study the largest cohorts of BSC patients reported worldwide. Most cases were reported on head and neck. Analysis of facial anatomic distribution shows that most commonly affected sites were the nose (43%) and the cheek (25%). The age at excision of metatypical BCC was higher than those of low-risk BCC (P < 0.05), however similar to high-risk BCC (P = 0.20). We revisited that the concept of BSC is the most similar to high-risk subtypes of BCC. Patients with diagnosed BSC have higher risk of second nonmelanoma skin cancer. Therefore, the frequency of follow-up examination should be adjusted to the individual risk of another skin cancer.

Basal Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches

Basal cell carcinoma (BCC) is the most common human cancer worldwide, and is a subtype of nonmelanoma skin cancer, characterized by a constantly increasing incidence due to an aging population and widespread sun exposure. Although the mortality from BCC is negligible, this tumor can be associated with significant morbidity and cost. This review presents a literature overview of BCC from pathophysiology to novel therapeutic approaches. Several histopathological BCC subtypes with different prognostic values have been described. Dermoscopy and, more recently, reflectance confocal microscopy have largely improved BCC diagnosis. Although surgery is the first-line treatment for localized BCC, other nonsurgical local treatment options are available. BCC pathogenesis depends on the interaction between environmental and genetic characteristics of the patient. Specifically, an aberrant activation of Hedgehog signaling pathway is implicated in its pathogenesis. Notably, Hedgehog signaling inhibitors, such as vismodegib and sonidegib, are successfully used as targeted treatment for advanced or metastatic BCC. Furthermore, the implementation of prevention measures has demonstrated to be useful in the patient management.

Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study

Background

A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates.

Objectives

To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure.

Methods

Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age², sex, phototype and non-occupational UV exposure were calculated.

Results

Participants with high versus no (OR 2.08; 95% CI 1.24–3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15–3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses.

Conclusion

The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

The effectiveness of photodynamic therapy and cryotherapy on patients with basal cell carcinoma: A systematic review and meta-analysis

Basal cell carcinoma (BCC) is known as the most common type of nonmelanoma skin cancer worldwide. The aim of this study is to show the effectiveness of photodynamic therapy and cryotherapy in patients with BCCs with the use of meta-analyses in order to see if there is a possible superiority of one treatment over the other. We searched the databases PubMed, MEDLINE, CINAHL, Scopus, OVID, Embase, Science Direct, JAMA Dermatology, and Research Gate in April 2020. The search combined related terms for cryotherapy, BCC, cryosurgery, cryoablation, laser and photodynamic therapy. The comparison of photodynamic therapy (PDT) vs cryotherapy on recurrence rate yielded no statistically significant results (Figure 2; N = 3 randomized control trials [RCTs]; Summary Random Effects OR = 4.99; P = .212). We observed large heterogeneity (I² = 87.3%), but no indication for small study effects (Egger's test, P = .02). Regarding the comparison of PDT vs cryotherapy on complete response, again no statistically significant results were observed (Figure 3; N = 2 RCTs; Summary Fixed Effects OR = 0.83; P = .538) and no indication of heterogeneity (I² = 0%). Our meta-analyses indicated that the comparison of PDT vs cryotherapy has no statistically significant results. Therefore, these therapies seem to have similar therapeutic effects.

Melanoma and non-melanoma skin cancer among patients who attended at King Khalid University Hospital in Riyadh, Saudi Arabia from 2007 - 2018

OBJECTIVES

To assess the prevalence of melanoma and non-melanoma skin cancer for patients attended King Khalid University Hospital, Riyadh, Saudi Arabia. We are also assessing the most common category of skin cancer to be encountered among those patients. Methods: The authors conducted a retrospective study including all patients (Saudi and non-Saudi) who attended King Khalid University Hospital (KKUH) at the period of (2007-2018). Data were collected from archives of Pathology Department at KKUH and categorized into: melanoma skin cancer (MSC), non-melanoma skin cancer (NMSC), which included: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), pre-neoplastic lesions, and non-neoplastic skin lesions. Results: A total of 111 patients were reported to have skin cancer out of 9828 cases, which had other skin pathology. Majority of cases were basal cell carcinoma with a total number of 76 (68.5%) of all cases. 18 patients (16.2%) were diagnosed with MSC. The remaining 17 patients (15.3%) were diagnosed with squamous cell carcinoma. Conclusion: Skin cancer prevalence and incidence is increasing worldwide. In our study, BCC was the most common type of skin cancer to be reported in our institute, which is similar to the majority of other international studies.

Hydrochlorothiazide use and the risk of skin cancer in patients with hypertensive disorder: a nationwide retrospective cohort study from Korea

BACKGROUND/AIMS

Recent studies have shown a cumulative dose-dependent association between the use of hydrochlorothiazide (HCTZ) and skin cancer, including melanoma and non-melanoma skin cancer (NMSC) in Western Europe. However, whether this pattern is present in East Asia countries is unknown. The aim of this study was to examine the association between HCTZ use and the risk of skin cancer among a cohort of hypertensive patients in South Korea.

METHODS

This was a retrospective, population-based cohort study using the database from the Health Insurance Review and Assessment Service between January 1, 2007 and June 30, 2017 in South Korea. We identified patients diagnosed with melanoma and NMSC in the cohorts of essential hypertensive patients who were treated with HCTZ or antihypertensive agents other than HCTZ. Using Cox proportional hazards regression models, the hazard ratios (HR) for skin cancer associated with HCTZ users were calculated.

RESULTS

The risk of melanoma was significantly lower in HCTZ-users compared with non-HCTZ users (HR, 0.85; 95% confidence interval [CI], 0.75 to 0.97; p = 0.016), and the risk of NMSC was lower in the HCTZ users but no statistically significant association was seen (HR, 0.96; 95% CI, 0.91 to 1.02; p = 0.236). High cumulative doses (≥ 50,000 mg) of HCTZ were associated with decreased risk of both NMSC (HR, 0.20; 95% CI, 0.10 to 0.38; p < 0.001) and melanoma (HR, 0.18; 95% CI, 0.04 to 0.70; p = 0.001), respectively.

CONCLUSION

High cumulative use of HCTZ may have a chemopreventive effect against the development of melanoma and NMSC with clear cumulative dose-response and duration-response relationships in South Korea.

Basal Cell Carcinoma Review

Basal cell carcinoma (BCC) is the most common malignancy and the incidence is rising. BCCs have low mortality but can cause significant morbidity primarily through local destruction. The pathogenesis is linked to the interplay between environmental and patient-derived characteristics. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates. This article reviews the epidemiology, staging, treatment, and prevention of BCC.

Predicting keratinocyte carcinoma in patients with actinic keratosis: development and internal validation of a multivariable risk-prediction model

BACKGROUND

Patients with actinic keratosis (AK) are at increased risk for developing keratinocyte carcinoma (KC) but predictive factors and their risk rates are unknown.

OBJECTIVES

To develop and internally validate a prediction model to calculate the absolute risk of a first KC in patients with AK.

METHODS

The risk-prediction model was based on the prospective population-based Rotterdam Study cohort. We hereto analysed the data of participants with at least one AK lesion at cohort baseline using a multivariable Cox proportional hazards model and included 13 a priori defined candidate predictor variables considering phenotypic, genetic and lifestyle risk factors. KCs were identified by linkage of the data with the Dutch Pathology Registry.

RESULTS

Of the 1169 AK participants at baseline, 176 (15·1%) developed a KC after a median follow-up of 1·8 years. The final model with significant predictors was obtained after backward stepwise selection and comprised the presence of four to nine AKs [hazard ratio (HR) 1·68, 95% confidence interval (CI) 1·17-2·42], 10 or more AKs (HR 2·44, 95% CI 1·65-3·61), AK localization on the upper extremities (HR 0·75, 95% CI 0·52-1·08) or elsewhere except the head (HR 1·40, 95% CI 0·98-2·01) and coffee consumption (HR 0·92, 95% CI 0·84-1·01). Evaluation of the discriminative ability of the model showed a bootstrap validated concordance index (c-index) of 0·60.

CONCLUSIONS

We showed that the risk of KC in patients with AK can be calculated with the use of four easily assessable predictor variables. Given the c-index, extension of the model with additional, currently unknown predictor variables is desirable. Linked Comment: Kim et al. Br J Dermatol 2020; 183:415-416.

Epidemiology of Skin Cancer: Update 2019

Melanoma and keratinocyte skin cancer (KSC) are the most common types of cancer in White-skinned populations. Both tumor entities showed increasing incidence rates worldwide but stable or decreasing mortality rates. Rising incidence rates of cutaneous melanoma (CM) and KSC are largely attributed to increasing exposure to ultraviolet (UV) radiation, the main causal risk factor for skin cancer.Incidence rates of KSC, comprising of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are much higher than that of melanoma. BCC development is mainly the cause of an intensive UV exposure in childhood and adolescence, while SCC development is related to chronic, cumulative UV exposure over decades. Although mortality is relatively low, KSC is an increasing problem for health care services causing significant morbidity.Cutaneous melanoma is rapidly increasing in White populations, with an estimated annual increase of around 3-7% over the past decades. In contrast to SCC, melanoma risk is associated with intermittent and chronic exposure to sunlight. The frequency of its occurrence is closely associated with the constitutive color of the skin and the geographical zone. Changes in outdoor activities and exposure to sunlight during the past 70 years are an important factor for the increasing incidence of melanoma. Mortality rates of melanoma show stabilization in the USA, Australia, and in European countries. In the USA even dropping numbers of death cases were recently reported, probably reflecting efficacy of the new systemic treatments.Among younger cohorts in some populations (e.g., Australia and New Zealand,), stabilizing or declining incidence rates of CM are observed, potentially caused by primary prevention campaigns aimed at reducing UV exposure. In contrast, incidence rates of CM are still rising in most European countries and in the USA. Ongoing trends towards thinner melanoma are largely ascribed to earlier detection.

Sun Safe Workplaces: Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

OBJECTIVE

Occupational skin cancer prevention is a priority because outdoor workers are exposed to high levels of ultraviolet radiation, the primary risk factor for skin cancer.

METHODS

A 2-year follow-up assessment of the impact of Sun Safe Workplaces (SSW), a workplace sun safety program that promoted policy adoption and education, on employee sun safety behavior was conducted. Sixty-three of 98 local government organizations from the original study participated.

RESULTS

Outdoor workers (n = 1724) completed surveys on personal sun protection practices. Employees' sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW's effect was mediated by the number of workplace actions to implement elements of the policy, including sun protection messages and equipment and employee reports of sun safety training.

CONCLUSION

Policy promotion is a feasible approach to occupational skin cancer prevention.

Photokeratitis induced by ultraviolet radiation in travelers: A major health problem

Ultraviolet (UV) irradiation is one of the several environmental hazards that may cause inflammatory reactions in ocular tissues, especially the cornea. One of the important factors that affect how much ultraviolet radiation (UVR) humans are exposed to is travel. Hence, traveling is considered to include a more acute UVR effect, and ophthalmologists frequently evaluate and manage the ocular manifestations of UV irradiation, including UV-induced keratitis. The purpose of this paper is to provide an evidence-based analysis of the clinical effect of UVR in ocular tissues. An extensive review of English literature was performed to gather all available articles from the National Library of Medicine PubMed database of the National Institute of Health, the Ovid MEDLINE database, Scopus, and ScienceDirect that had studied the effect of UVR on the eye and its complications, between January 1970 and June 2014. The results show that UVR at 300 nm causes apoptosis in all three layers of the cornea and induces keratitis. Apoptosis in all layers of the cornea occurs 5 h after exposure. The effect of UVR intensity on the eye can be linked to numerous factors, including solar elevation, time of day, season, hemisphere, clouds and haze, atmospheric scattering, atmospheric ozone, latitude, altitude, longitudinal changes, climate, ground reflection, and geographic directions. The most important factor affecting UVR reaching the earth's surface is solar elevation. Currently, people do not have great concern over eye protection. The methods of protection against UVR include avoiding direct sunlight exposure, using UVR-blocking eyewear (sunglasses or contact lenses), and wearing hats. Hence, by identifying UVR intensity factors, eye protection factors, and public education, especially in travelers, methods for safe traveling can be identified.

Skin cancer incidence in rural workers at a reference hospital in western Paraná

BACKGROUND

Skin cancer is common in Brazil and is related to sun exposure, among other risk factors. There are no data on the incidence of malignant skin neoplasm in rural workers in western Paraná.

OBJECTIVE

To analyze the incidence and profile of rural workers who were diagnosed with skin cancer at a reference service in Cascavel, western Paraná, in the last five years (2011-2016).

METHODS

This retrospective cross-sectional study was carried out through a review of the anatomopathological reports of rural workers diagnosed with skin cancer at Cascavel Oncology Center (CEONC), in Cascavel. The following variables were collected: year of diagnosis, age, gender, injury location and histological subtype.

RESULTS

A total of 681 cases of malignant epithelial neoplasia were identified, with a higher frequency in the 61-70 age group. Data analysis showed an increase of about 210% in the occurrence of skin cancers in the last 5 years. The cephalic region was the most affected, and the most common histological subtype was nodular basal cell carcinoma. There was no association between gender and location.

STUDY LIMITATIONS

This is a retrospective study and analysis of a secondary data bank.

CONCLUSION

This study is a regional estimation of the incidence of cutaneous neoplasms and provides evidence of a considerable increase in the number of diagnoses in rural workers from western Paraná, Brazil. Moreover, it is possible to conclude that the sample group studied is at risk of developing skin cancer.

Extremity nevus count is an independent risk factor for basal cell carcinoma and melanoma, but not squamous cell carcinoma

BACKGROUND

The presence of nevi portends an increased risk for melanoma.

OBJECTIVE

We sought to examine the association between extremity nevus count and the risk of melanoma and keratinocyte cancers.

METHODS

We evaluated prospective cohorts of 176,317 women (the Nurses' Health Study, 1986-2012 and the Nurses' Health Study 2, 1989-2013) and 32,383 men (Health Professionals Follow-up Study, 1986-2012). Information on nevus count (none, 1-5, 6-14, ≥15) on the extremity was collected at baseline.

RESULTS

There were 1704 incident cases of melanoma, 2296 incident cases of squamous cell carcinoma, and 30,457 incident cases of basal cell carcinoma, with a total of 4,655,043 person-years for melanoma and 4,267,708 person-years for keratinocyte cancers. The presence of an extremity nevus was associated with an increased risk of melanoma in all anatomic areas and increased risk of basal cell carcinoma (BCC). Individuals with ≥15 nevi had the highest risk of melanoma and BCC compared to those without any extremity nevi (melanoma hazard ratio 2.79 [95% confidence interval 2.04-3.83]; BCC HR 1.40 [95% confidence interval 1.32-1.49]). No significant association was observed for squamous cell carcinoma.

LIMITATIONS

Limitations of our study included self-reported nevus count and detection bias.

CONCLUSIONS

Extremity nevus count is a helpful clinical marker in risk-stratifying individuals for BCC and melanoma on all body sites.

Overweight in midlife and risk of cancer in late life: A nationwide Swedish twin study

Our study examined whether midlife overweight (body mass index [BMI] ≥25) is associated with late-life cancer risk and explored the role of genetic and early-life environmental factors in this association. The study included 14,766 individuals from the Swedish Twin Registry, whose midlife (30-50 years) height and weight were recorded. Information on cancer diagnoses in late life (>65 years) was derived from the National Patient Registry and Cancer Registry. Generalized estimating equation (GEE) models were used to analyze unmatched case-control data (controlled for the clustering of twins within a pair). A co-twin matched case-control analysis used conditional logistic regression to compare cancer-discordant twins. Of all participants, 3968 (26.9%) were overweight and 4253 (28.8%) had cancer. In multi-adjusted GEE models using normal-weight (BMI 18.5-24.9) participants as the reference group, overweight was related to higher risk of colon cancer (OR 1.36, 95% CI: 1.00-1.84, p = 0.049), liver cancer (OR 2.00, 95% CI: 1.11-3.62), cervix uteri cancer (OR 2.86, 95% CI: 1.19-6.91) and corpus uteri cancer (OR 1.78, 95% CI: 1.14-2.78) but lower risk of nonmelanoma skin cancer (OR 0.77, 95% CI: 0.66-0.90). In conditional logistic regression analysis, these associations were attenuated becoming nonsignificance. The difference in ORs from the unmatched and matched analyses was not significant. In conclusion, midlife overweight is associated with increased risk of late-life colon, liver and uterine cancer but reduced risk of late-life nonmelanoma skin cancer. Further investigations are warranted to explore the role of genetic and early-life environmental factors in these associations.